22B-055 (3) BP-2022-1489
56 SPRING ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lo :
22B-055-001 CITY OF NORTHAMPTON
Permit: Exterio Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2022-1489 PERMISSION IS HEREBY GRANTED TO:
Project# WINDOW Contractor: License:
Est. Cost: 15200 PELLA PRODUCTS, INC 096558
Const.Class: Exp.Date: 03/01/2024
Use Group: Owner: ARCHAMBAULT JOAN M
Lot Size (sq.ft.)
Zoning: WP/WSP Applicant: PELLA PRODUCTS, INC
AI 'licant Ad t. • Phone: Insurance:
155 MAIN ST 6H15382
GREENFIELD, MA 01301
ISSUED ON. 11/16/2022
TO PERF t'RM THE FOLLOWING WORK:
INSTALL 10 R:PLACEMENT WINDOWS
POST THIS ARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plu i bing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter: Footings:
Rough: Rough: House# Foundation:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
/ --
r -;--
i. NOV 1
The Commonwealth of Massachusetts/ 4 20�2 / Fr
R
Board of Building Regulations and,$tandat:
wt Massachusetts State Building Code,780 CM1 r
LITY
�N 4^,ull�'",`;,�isQ JJSE
Building Permit Application To Construct,Repair,Renovate Or DePilyFeo, evisekl Mar 2011
One-or Two-Family Dwelling
This on For Official Use Only
Buildin Permit' Number: �f P'��- ' ,�� Date Applied:
t=1v,,� �J�oss //Z. 11 -!5 Z6Zi.
Buildin Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Prope Addres • 1.2 es rs a &Parcel Numbers
1.1 a Is-this an aV6pted street?yes (� no Map Number Parcel Number
t63 Zon.ng Information: 1.4 Property Dimensions:
iQeithei I kish not
Zoning District Proposed Use' Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: Outside Flood Zone?
— Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record•
-T tr, RroI-vimbatt1�' 1[Drenoea MIA ()Ia(oa
Name(Pr nt) City,State,ZIP
% 1)6 9 Stet- 1-11 -d U-q'193
o.and St eet Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2:f j 1('� 1 ne I u;l O( j usg ri j PX►511 rig nppni l(1S
(O i S-h n b ehan -� -the 'bu,Id 1ld9s IQ
�.er. J
U -Faotvr 0.30
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 15,a00.(,0 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee
0 Total Project Cost' (Item 6)x multiplier x
3.Plumbing $ )6 2. Other Fees: $
4.Mechanical (HVAC) $ 0 List:
5.Mechanical (Fire $ ,C/ Total All Fee : $�
Suppression) 40
Check Nod Check Amount:
6.Total Project Cost: $ 6 000 to 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Con truction Supervisor License(CSL) n en0C / 56Q
f rP i r License I(
Number
m b Expiration Date
Name of 1 SL Holder I ,
R. List CSL Type(see below) u
l o ` 'q' ie. are - T Description
No.and S e
U Unrestricted(Buildings up to 35,000 Cu.ft.)
:AiRestricted 1&2 Family Dwelling
City/To5,S•:te,ZIP M Masonry
j RC Roofing Covering
C WS Window and Siding
l� SF Solid Fuel Burning Appliances 14 � ����
I Insulation
Telephon Email address D Demolition
5.2 Re u:terreed Home Improvement Contractor(HIC) ;I rig
cesicza
M C-I I/ `t'f t �.-(-� I n t✓• HIC Registration Number Ex irati n Date lit
M
HIC
any 0Nl h e o�treptrant Name
o.and S4 vcei, Illit),In
b`2�1 �I - �oEmail address
City/To , t ZJll Telephone O
S DCTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6))
Workers ompensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affi•:vit will result in the denial of the Issuance of the building permit.
Signed •ffidavit Attached? Yes to No 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMITI
I,as 0 er of the subject property,hereby authorizWeebr ( SS 4 Vella i `t�' 'cd(1 els
to act on y behalf,in all matters relative to work authorized by this building permit application.
31 n Aroha mbcau.l l- -see, Web Webec1 ►ll g pboa.
Print • er's Name(Electronic Signature) Date
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
By enter 1 g my name below,I hereby attest under the pains and penalties of perjury that all of the information
contain•a in this application is true and accurate to the best f my knowledge and ding.
—11.- . 'Br PellaTh Lt c----. abaa
Print s er's or Authorized Agent's Name(Electronic Sign re) Date
NOTES:
1. An o er who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not 1 egistered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
pro_i am or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
w .mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. Wh:+ substantial work is planned,provide the information below:
Total fl•'r area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross li ••g area(sq. ft.) Habitable room count
Number .f fireplaces Number of bedrooms
Number •f bathrooms Number of half/baths
Type of eating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for`Total Project Cost"
I. The Commonwealth of Massachusetts
Department of Industrial Accidents
i Office of Investigations
—1r7i- Lafayette City Center
1. '�
2 Avenue de Lafayette, Boston,MA 02111-1750
www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(I3usiness/Organization/Individual): Pella Products, Inc.
Address:155 Main St
City/State/Zip:Greenfield,MA 01301 Phone#:413-774-0153
—
Are you an employer?Check the appropriate box: Type of project(required):
1.❑■ I am a employer with 50 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
listed on the attached sheet. 7. ❑■ Remodeling
2.Ill I am a sole proprietor or partner-
ship and have no employees These sub-contractors have g. ❑Demolition
workingfor me in anyace employees and have workers'
P h• $ 9. ❑Building addition
[No workers' comp.insurance comp.insurance. 10. Electrical repairs or additions
required.] 5. ❑ We are a corporation and its ❑ ep
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
instrance required.]t c. 152,§1(4),and we have no
employees. [No workers' 13.0 Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
*Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. L"the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
InsuranceCompany Name: EMC Insurance Companies
Policy#o Self-ins.Lic.#:6H15382 Expiration Date:01-01-2023
Job Site A dress: Spri no, Si-re - City/State/Zip: Y
Attach a py of the workers' co ensation policy declaration page(showing the policy number and expiration date).
Failure to ure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$ 0.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigate ns of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties o 'perjury that the information provided above is true and correct.
Signature: �/ 6.4/ Date: I"l a laa
Phone#: 4 -€,i a— 5"I fQ(
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(check one):
1❑Board of Health 211 Building Department 3fCity/Town Clerk 4.0 Electrical Inspector 5.0Plumbing
Inspector 6.00ther
Contact Person: Phone#:
,
PELLA PRODUCTS INC.
155 MAIN STREET
GREENFIELD, MA. 01301
Date: 10 3.
To: I own off" fhreire
49i Pain Skr -i- , f orO ryon , MO 0I oI,D
Subject: Disposal of Debris
The purpose of this letter is to certify that all debris from any project
undertaken by Pella Products, Inc. in your town will be transported to
a dumpster at our main facility; 155 Main Street, Greenfield, MA.
Pella Pr o
ducts, Inc. is under contract with Waste Management of Massachusetts
For the disposal of the contents of this dumpster.
Very tr ly yours,
PELLA RODUCTS, INC.
Joy Grover
Accounting Manager
Pella Products, Inc.
155 Main Street
Greenfield, MA 01301
Office:413-512-5968 Cell:413-834-8799
To: Building inspector
From:Trevor Bross—Installation Manager
Date: February 17, 2022
Subject: Building Permit Applications& Designees
Pella Products Incorporated is in the business of replacing windows and doors for our customers. Our process includes
providing a building permit for each and every project.
I am a licensed Construction Supervisor. Building Permits will be applied for using my CSL#CS-096558 and my
HIC# 142279. Please find a copy of my licenses below.
It commonwealth of Massachusetts Construction Supervisor
Division of Occupational Licensure Unrestricted -Buildings of any use group which contain
Board of Building Reaulatwns and Standards less than 35,000 cubic feet(991 cubic meters)of enclosed l
Constt liCmowt Space.
CS- 558 etpires:0310112024
0 FOR E �,
ill
31*
1, 4V Failure to possess a current edition of the Massachusetts
4 State Building Code is cause for revocation of this license.
Com mssioner For information about this license
Cali(617)727 3200 or visa www,nasa.yov/dpt
THE COMMONWEALTH OF MASSACHUSETTS
ee of Consumer Affairs&Business Regulation Registration valid for individual use only before the
HOME IMPROVEMENT CONTRACTOR expiration date. If found return to:
TYPE:Supplement Card Office of Consumer Affairs and Business Regulation
Registration Expiration 1000 Washington Street -Suite 710
142279 03./23,2024 Boston,MA 02118
'ELLA PRODUCTS.INC.
IF'
REV R BROSS ""e-'' ""'f
55 M N STREET u a iza,qL id a ,
3REE FIELD,MA 01301
Undersecretary _ N9t,valid without signature
Each Installation will be staffed by our installers who are all licensed in accordance with current building codes. Below
listed are our installers and their license numbers. Please accept these individuals as my designees.
Willard Brown CS106010 Vladimir Shevchuk CSSL099209
Scott Bowdish CSSL100232 Bill Leger CS89338
Christian Lambert CS065102 Robert Kairnes CS113305
Igor Kravchuk CS094911
Contract - Detailed
‘f0 Pella Window and Door Showroom of Greenfield Sales Rep Name: Rousseau, Mitchell
240 Mohawk Trail Sales Rep Phone: 413-768-8379
Greenfield, MA 01301-3209 Sales Rep Fax:
Phone: (413) 774-7231 Fax: (413) 774-6348 Sales Rep E-Mail: mrousseau@pellasales.com
Customer Information Project/Delivery Address Order Information
Joan Archambault Archambault Joan 56 Spring St Florence MA Quote Name: Joan Archambault-56 Spring St,Florence,MA,
56 Spring St 52 STORE
56 Spring St Order Number: 739X3KR241
Florence, MA 01062-1261 Lot# Quote Number: 16102610
Primary Phone:(413)2759778 Florence, MA 01062 Order Type: Installed Sales
Mobile Phone: County: Hampshire Payment Terms: C.O.D.
Fax Number: Tax Code: MASS
E-Mail: Quoted Date: 10/13/2022
Great Plains#: 1006588786
Customer Number: 1010402584
Customer Account: 1006588786
Line# Location: Attributes
10 Dining Room Lifestyle, Double Hung, 800.10 X 946.150, Without HGP, Putty Item Price Qty Ext'd Price
-amomms $1,561.22 2 $3,122.44
J3 1:Non-Standard SizeNon-Standard Size Double Hung,Equal
PK# Frame Size: 31 1/2 X 37 1/4
clLommommomP General Information: No Package,Without Hinged Glass Panel,Clad,Pine, 5",3 11/16",Jambliner Color: Gray
�.y Q 2124 Exterior Color/Finish: Standard Enduraclad,Putty
Interior Color/Finish: Unfinished Interior
1 Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
Hardware Options: Cam-Action Lock,Satin Nickel,No Limited Opening Hardware,Order Sash Lift,No Integrated Sensor
Viewed From Exterior Screen: No Screen
Performance Information: U-Factor 0.30,SHGC 0.30,VLT 0.56,CPD PEL-N-35-00426-00001,Performance Class LC,PG 50,Calculated Positive DP
Rating 50,Calculated Negative DP Rating 50,Year Rated 08111,Clear Opening Width 28.312,Clear Opening Height 15.375,Clear Opening Area
3.022896,Egress Does not meet typical United States egress,but may comply with local code requirements
Remake:,
Grille: No Grille,
Wrapping Information: No Exterior Trim,3 11/16",5", Factory Applied,Pella Recommended Clearance,Perimeter Length=138".
Frame Size:800.10 X 946.150
PF-9-Lifestyle PFit(Backer rod,caulk,frm exp&3/8 jmb plugs) Qty 1
For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com
Printed on 10/28/2022 Contract-Detailed Page 1 of 11
Customer:Joan Archambault Project Name: Archambault Joan 56 Spring St Florence MA Order Number: 739X3KR241 Quote Number: 16102610
Line# Location: Attributes
15 Bathroom Lifestyle, Double Hung, 596.90 X 946.150, Without HGP, Putty Item Price Qty Ext'd Price
$1,661.31 1 $1,661.31
4 1: Non-Standard SizeNon-Standard Size Double Hung,Equal
sa
PK# Frame Size: 23 1/2 X 37 1/4
2124 General Information: No Package,Without Hinged Glass Panel,Clad, Pine,5", 3 11/16",Jambliner Color: Gray
el 0, Exterior Color/Finish: Standard Enduraclad,Putty
Interior Color/Finish: Unfinished Interior
- Glass: Insulated Tempered Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
Hardware Options: Cam-Action Lock,Satin Nickel,No Limited Opening Hardware,Order Sash Lift,No Integrated Sensor
Viewed From Exterior Screen: No Screen
Performance Information: U-Factor 0.30,SHGC 0.30,VLT 0.56,CPD PEL-N-35-00427-00001,Performance Class LC,PG 50,Calculated Positive DP
Rating 50,Calculated Negative DP Rating 50,Year Rated 08111,Clear Opening Width 20.312,Clear Opening Height 15.375,Clear Opening Area
2.168729,Egress Does not meet typical United States egress,but may comply with local code requirements
Remake: ,
Grille: No Grille,
Wrapping Information: No Exterior Trim,3 11/16",5",Factory Applied,Pella Recommended Clearance,Perimeter Length=122".
Frame Size:596.90 X 946.150
PF-9-Lifestyle PFit(Backer rod,caulk,frm exp&3/8 jmb plugs) Qty 1
Line# Location: Attributes
20 Bedroom Lifestyle, Double Hung, 800.10 X 946.150, Without HGP, Putty Item Price Qty Ext'd Price
$1,561.22 2 $3,122.44
1:Non-Standard SizeNon-Standard Size Double Hung,Equal
PK# Frame Size: 31 1/2 X 37 1/4
2124 General Information: No Package,Without Hinged Glass Panel,Clad, Pine,5",3 11/16",Jambliner Color: Gray
Exterior Color/Finish: Standard Enduraclad,Putty
Interior Color/Finish: Unfinished Interior
I Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
Hardware Options: Cam-Action Lock,Satin Nickel,No Limited Opening Hardware,Order Sash Lift,No Integrated Sensor
Viewed From Exterior Screen: No Screen
Performance Information: U-Factor 0.30,SHGC 0.30,VLT 0.56,CPD PEL-N-35-00426-00001,Performance Class LC,PG 50,Calculated Positive DP
Rating 50,Calculated Negative DP Rating 50,Year Rated 08111,Clear Opening Width 28.312,Clear Opening Height 15.375,Clear Opening Area
3.022896,Egress Does not meet typical United States egress,but may comply with local code requirements
Remake:,
Grille: No Grille,
Wrapping Information: No Exterior Trim,3 11/16",5",Factory Applied,Pella Recommended Clearance,Perimeter Length=138".
Frame Size:800.10 X 946.150
PF-9-Lifestyle PFit(Backer rod,caulk,frm exp&3/8 jmb plugs) Qty 1
For more information regarding the finishing, maintenance, service and warranty of all Pella4'4 products,visit the Pella®website at www.pella.com
Printed on 10/28/2022 Contract-Detailed Page 2 of 11
Customer: Joan Archambault Project Name: Archambault Joan 56 Spring St Florence MA Order Number: 739X3KR241 Quote Number: 16102610
Line# Location: Attributes
25 Den Lifestyle, Double Hung, 800.10 X 946.150, Without HGP, Putty Item Price Qty Ext'd Price
I� � � $1,561.22 2 $3,122.44
1: Non-Standard SizeNon-Standard Size Double Hung,Equal
ibi ei. I PK# Frame Size: 31 1/2 X 37 1/4
ti 2124 General Information: No Package,Without Hinged Glass Panel,Clad,Pine, 5",3 11/16",Jambliner Color: Gray
Q Exterior Color/Finish: Standard Enduraclad,Putty
Interior Color/Finish: Unfinished Interior
I Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
Hardware Options: Cam-Action Lock,Satin Nickel,No Limited Opening Hardware,Order Sash Lift,No Integrated Sensor
Viewed From Exterior Screen: No Screen
Performance Information: U-Factor 0.30,SHGC 0.30,VLT 0.56,CPD PEL-N-35-00426-00001,Performance Class LC,PG 50,Calculated Positive DP
Rating 50,Calculated Negative DP Rating 50,Year Rated 08111,Clear Opening Width 28.312,Clear Opening Height 15.375,Clear Opening Area
3.022896,Egress Does not meet typical United States egress,but may comply with local code requirements
Remake:,
Grille: No Grille,
Wrapping Information: No Exterior Trim,3 11/16",5",Factory Applied,Pella Recommended Clearance,Perimeter Length=138".
Frame Size:800.10 X 946.150
PF-9-Lifestyle PFit(Backer rod,caulk,frm exp&3/8 jmb plugs) Qty 1
Line# Location: Attributes
30 Den Lifestyle, Double Hung, 901.70 X 946.150, Without HGP, Putty Item Price Qty Ext'd Price
I $1,909.61 1 $1,909.61
1: Non-Standard SizeNon-Standard Size Double Hung,Equal
PK# Frame Size: 35 1/2 X 37 1/4
2124 General Information: No Package,Without Hinged Glass Panel,Clad,Pine,5",3 11/16",Jambliner Color: Gray
Exterior Color/Finish: Standard Enduraclad,Putty
Interior Color/Finish: Unfinished Interior
I Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
Hardware Options: Cam-Action Lock,Satin Nickel,No Limited Opening Hardware,Order Sash Lift,No Integrated Sensor
Viewed From Exterior Screen: No Screen
Performance Information: U-Factor 0.30,SHGC 0.30,VLT 0.56,CPD PEL-N-35-00426-00001,Performance Class LC,PG 35,Calculated Positive DP
Rating 35,Calculated Negative DP Rating 35,Year Rated 08111,Clear Opening Width 32.312,Clear Opening Height 15.375,Clear Opening Area
3.449979,Egress Does not meet typical United States egress,but may comply with local code requirements
Remake: ,
Grille: No Grille,
Wrapping Information: No Exterior Trim,3 11/16",5",Factory Applied,Pella Recommended Clearance,Perimeter Length=146".
Frame Size:901.70 X 946.150
PF-9-Lifestyle PFit(Backer rod,caulk,frm exp&3/8 jmb plugs) Qty 1
For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com
Printed on 10/28/2022 Contract-Detailed Page 3 of 11
Customer: Joan Archambault Project Name: Archambault Joan 56 Spring St Florence MA Order Number: 739X3KR241 Quote Number: 16102610
Line# Location: Attributes
35 TV room Lifestyle, Double Hung, 901.70 X 946.150, Without HGP, Putty Item Price Qty Ext'd Price
i $1,909.61 2 $3,819.22
1: Non-Standard SizeNon-Standard Size Double Hung,Equal
PK# Frame Size: 35 1/2 X 37 1/4
2124el
General Information: No Package,Without Hinged Glass Panel,Clad,Pine,5",3 11/16",Jambliner Color: Gray
4 Exterior Color/Finish: Standard Enduraclad,Putty
Interior Color/Finish: Unfinished Interior
I -. Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
Hardware Options: Cam-Action Lock,Satin Nickel,No Limited Opening Hardware,Order Sash Lift,No Integrated Sensor
Viewed From Exterior Screen: No Screen
Performance Information: U-Factor 0.30,SHGC 0.30,VLT 0.56,CPD PEL-N-35-00426-00001,Performance Class LC,PG 35,Calculated Positive DP
Rating 35,Calculated Negative DP Rating 35,Year Rated 08111,Clear Opening Width 32.312,Clear Opening Height 15.375,Clear Opening Area
3.449979,Egress Does not meet typical United States egress,but may comply with local code requirements
Remake: ,
Grille: No Grille,
Wrapping Information: No Exterior Trim,3 11/16",5",Factory Applied,Pella Recommended Clearance,Perimeter Length=146".
Frame Size:901.70 X 946.150
PF-9-Lifestyle PFit(Backer rod,caulk,frm exp&3/8 jmb plugs) Qty 1
Line# Location: Attributes
40 None Assigned BPC - Permit-subject to change if actual cost greater than shown Item Price Qty Ext'd Price
$90.00 1 $90.00
For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com
Printed on 10/28/2022 Contract-Detailed Page 4 of 11
' DocuSign Envelope ID:B11D93A6-B07E-4D20-8C76-95ED4C632C48
t,ustorner:Joan Hrenarnuault rroject Name: Joan Archambault-56 Spring St, Florence,MA,US Order Number: 739 Quote Number: 16102610
Joan Archambault Mitchell Rousseau Order Totals
Customer Name (Please print) Pella Sahs Rgp.Name (Please print) Taxable Subtotal $9,661.18
—DocuSigned by: - - �- aS�gned Y
e.tuA, gratamlittutt ifdu.Lt lebUSS att Sales Tax @ 6.25% $603.82
•CustotnegeFigo re PetMS RcR 'fr 4gnature
Non-taxable Subtotal $4,935.00
10/14/2022 10/14/2022 Total $15,200.00
DaoocuSigned by: Date Deposit Received $4,123.00
r3ONA, iriaL Amount Due $11,077.00
rrealtraami3Ptpp4oval Signature
For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella.com
Printed on 10/14/2022 Contract-Detailed Page 9 of 9
DocuSign Envelope ID:B11D93A6-B07E-4D20-8C76-95ED4C632C48
Pella Products Inc.
155 Main Street
Greenfield, MA 01301
To Whom it may Concern:
I,Joan Archambault , as property owner, give permission to our contractor, Pella
Products Inc.to obtain a building permit for the installation of windows and/or doors in my home.
Located at; 56 Spring St
Florence, MA, 01062
Please accept this letter in place of my signature on the permit application.
Thank you,
DocuSigned by:
Signature:5111A' a► s
B172CF98A3FD456...
Date: 10/14/2022
�'...NN PELLPRO-01 CHRISTINE
'4�oRo CERTIFICATE OF LIABILITY INSURANCE DATE D/YYYY)
12/6/2021
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER C NTACT Christine Sullivan
NAME:
Phillips Insurance Agency,Inc. PHONE FAX
97 Center Street rail EA:(413)594-5984 wc,No):(413)592-8499
Chicopee,MA 01013 Vass;SS;christine@phillipsinsurance.com
INSURERS)AFFORDING COVERAGE NAIC#
INSURER A:EMC Insurance Companies 21415
INSURED INSURER B:Union Insurance Co of Providen
Pella Products,Inc INSURERC:
155 Main St I INSURERD:
Greenfield,MA 01301
'INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR—HE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESP ECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADM SUBR POLICY NUMBER POLICY EFF POLICY EXP UMI�
LTR INSD WVD IMMIDDIYYYYI IMMIDD/YYYY)
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE X OCCUR 6A15382 1/1/2022 1/1/2023 PREM DAMAGISEES(TOEa RENTED occurrence) $ 500,000
MED EXP(Any one person) $ 10,000
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY X Ef LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER: $
A AUTOMOBILE UABILITY (EaaMacci SINGLE LIMITdent) $
X ANY AUTO 6Z15382 1/1/2022 1/1/2023 BODILY INJURY(Per person) $
AUTEO�S ONLY SCHEDULEDAUNyy� BODILY INJURY(Per accident) $ 1,000,000
AUTOS ONLY AUTO ONLY (P2eraPERTY DAMAGE $
deM)A X UMBRELLA LA $B X OCCUR EACH OCCURRENCE $ 4,000,000
EXCESS UAB CLAIMS-MADE 6J15382 1/1/2022 1/1/2023 AGGREGATE $
DED X RETENTION$ 10,000 Aggregate $ 4,000,000
B ANDREMPLOYOERS LIABIUTY STATUTE ERH
ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 6H15382 1/1/2022 1/1/2023 500,000
FFICER/MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $
(Mandatory in NH) 500,000
E.L.DISEASE-EA EMPLOYEE $
If yes,describe under 500,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT, $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Installation Floater$50,000 Included
Operations usual to the sale and installation of doors&windows.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town of Florence(Northampton)BuildingCommissioner's THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
( p ) ACCORDANCE WITH THE POLICY PROVISIONS.
Office
212 Main Street
Northampton,MA 01060 AUTHORIZED REPRESENTATIVE IZ
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